Disease Detectives to be Hired

Bioterrorism Specialists Planned for Local Jurisdictions

In August, the Virginia Department of Health expects to receive federal money to hire an army of epidemiologists and bioterrorism coordinators, with the intentions of dispatching one each to the 35 health districts including Fairfax, Arlington and Loudoun counties, as well as the city of Alexandria.

In all, the state will be filling about 130 newly created bioterrorism-related jobs at the local and state level through the combination of two federal grants totaling $23.75 million and $1.8 million in state funds.

"This means a lot to us," said JoAnne Jorgenson, Fairfax County Health Department acting administrative director. "Currently we do the best we can with epidemiology work, but with the size of the county it's overwhelming."

AN EPIDEMIOLOGIST is a sort of disease detective, a specialist who investigates the outbreaks of disease for its cause, risk to others and possible future prevention.

The bioterrorism coordinator will do just that, coordinate the efforts of the local health department, hospitals and others within the medical community as well as help smooth the way for cooperation between federal, state and local agencies.

"The epidemiologist does disease investigations by looking at patterns from reports from the local hospitals," said Nancy Winter, state Department of Health public relations director. "The bioterrorism coordinator will develop relationships within the community and the hospitals."

Winter said the state health department expects to receive the federal grant money by August, which will then be spent over the next 18 months. After that, Winter said it will be up to the Bush Administration as to whether the funding will continue on a federal level. Jorgenson, for one, is hopeful the positions will be permanent.

"We've been assured the program will continue for at least four or five years," she said.

WHILE THE MOTIVATION behind the new positions were the Sept. 11 terrorist attacks, the anthrax mailings and the continued threat of a bioterrorism attack across the country, as far as the epidemiologists are concerned, there will be plenty to keep them busy on a local level. Part of their job will include investigating outbreaks of any communicable diseases such as hepatitis, meningitis and tuberculosis as well as foodborne diseases and even non contagious illness such as Lyme disease.

"Keep in mind, it is still more likely to have a naturally occurring disease outbreak than bioterrorism," said Dr. Susan Allan, Arlington Health Department director and a member of the state oversight committee that made the grant requests. "This will give us a better chance to collect and methodically track outbreaks."

Across the state there has been an increase in tuberculosis cases and Arlington is at the top of the list. Allan said the county commonly sees cases of meningitis, hepatitis, syphilis, HIV, salmonella, E. coli and even cases of gastritis, or a common stomach ache can be a sign of something larger.

"There is no difference in identifying a bioterrorism disease from a naturally occurring disease," Allan said. "We're adding another level of trend investigation. We'll be able to investigate earlier on and long-term investigation may lead to prevention."

THE LOCAL HEALTH DEPARTMENTS have someone on staff who does epidemiology work now, but because of the lack of resources an investigation in some cases may take longer to begin.

Jorgenson said, for example, while there are diseases such as tuberculosis that the county department begins investigating immediately, or with one reported case, others such as salmonella may take up to four or five reported cases before the department can devote the resources to an investigation. Having an epidemiologist will allow the investigations to begin sooner, she said.

The epidemiologist will also be able to collect data from area doctors and hospitals to see if there are trends overall that may not be identified by looking at the records of a single caregiver.

"Communicable disease are a big issue for Fairfax County because of the population," Jorgenson said. "We have a bigger number of communicable diseases that exist and we have a large county."

Jorgenson said one of the reasons for the increase in diseases, especially tuberculosis, is the large immigrant population. She said a person could be healthy in their home country and become sick when they move to the county.

"Tuberculosis can live in a body for years. Once they come to a new environment, it can trigger an outbreak," she said.

Nursing homes residents are also more susceptible to communicable diseases, although Jorgenson said anyone can be exposed at anytime.

Loudoun County, by contrast, has a low tuberculosis rate but faces other dangers an epidemiologist can help with.

Dr. David Goodfriend, Loudoun County Health Department director, said the county has the largest outbreak of Lyme disease in the state and last year even had a reported case of Whooping cough.

"When we did have anthrax and bioterrorism here we found out how important it was to find the disease early," Goodfriend said. "The epidemiologist will help us with the diseases we're currently doing and kick it up another level to get the information out to the doctors."